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Lormans T, de Graaf E, de Vries S, Leget C, Teunissen S. 'It is important to feel invited': what patients require when using the Utrecht Symptom Diary - 4 Dimensional, a qualitative exploration. Palliat Care Soc Pract 2024; 18:26323524241260426. [PMID: 38911602 PMCID: PMC11191620 DOI: 10.1177/26323524241260426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background In palliative care, the Utrecht Symptom Diary - 4 Dimensional (USD-4D), a Dutch-adapted and validated patient-reported outcome measure, supports multidimensional symptom management through identification and monitoring of, as well as dialogue on symptoms and needs. For the USD-4D to optimally support patients' autonomy, it is essential to know what patients need to use it. Objective This study aims to identify what patients need when using the USD-4D in clinical palliative care. Design A generic qualitative design with primary and secondary analyses of semistructured interviews. Methods Patients ⩾18 years with a life-limiting illness were purposefully recruited within hospice and home care settings if they were in their last year of life as identified by the surprise question. Patients had to be aware of their life-threatening condition. Patients were selected in two tranches. In the first tranche, patients had to have completed the USD-4D at least once. The second tranche consisted of patients who were not familiar with the USD-4D in clinical practice and were interviewed in a previous study on the content validity of the USD-4D. The interviews were transcribed verbatim and were subjected to thematic analysis. Results Twenty-five patients were included (14 men, ages 44-87). Patients' needs when using the USD-4D were summarized in three themes: (1) feeling invited, (2) being aware of the purpose and function of the USD-4D, and (3) experiencing a personal and nonjudgmental approach. Conclusion For patients to optimally benefit from the USD-4D as a supportive measure of their autonomy in clinical palliative care, it is essential that they feel invited to use it. Healthcare providers are tasked with setting the right preconditions for patients to want and to be able to use the USD-4D. For patients, this means healthcare providers should always be attuned to their personal preferences when communicating the purpose and function of the USD-4D and when they enter into dialogue with them.
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Affiliation(s)
- Tom Lormans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584CG, The Netherlands
| | - Everlien de Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sita de Vries
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo Leget
- Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Haufe M, Leget C, Potma M. Better spiritual support for people living with early stage dementia: Developing the diamond conversation model. DEMENTIA 2024; 23:91-108. [PMID: 37934923 PMCID: PMC10797830 DOI: 10.1177/14713012231213907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND People with early-stage dementia could benefit greatly from on-going spiritual support. However, health care professionals working in dementia care often do not have a clear idea of what such support might entail. There is a lack of tools that can help professionals provide such support. The Diamond conversation model used in palliative care could provide such a support. Aims: To develop the Diamond model for early-stage dementia so that professionals can provide better spiritual support. METHODS Participatory research was conducted. Reflective interviews with chaplains, case managers and health psychologists identified frequently occurring existential and spiritual issues of clients and family members. A core participatory group consisting of chaplains, a psychologist and a researcher further analysed these issues thematically and co-developed the Diamond model for early stage dementia over three co-creation sessions. Researchers with Diamond model expertise provided feedback to the core participatory group in between these sessions based on the session output. FINDINGS Central existential and spiritual issues were found to be: self-confidence and -worth, adaptability and capacity, security and loss, burden and enrichment of memory and faith and meaning. The five polarities of the Diamond model were found helpful to understand tensions surrounding these issues. Specific tensions were identified between maintaining a self and being valued, finding direction in what to do and a way to bear changes in ability, a strong need for attachment and letting go of past ways to relate to one another, the renewed intensity of long term memories and decline of the short term ones and surrendering to one's life situation and wanting certainty and meaning. CONCLUSIONS The newly developed Diamond model for people with early-stage dementia offers a valuable framework to help professionals provide conversational support. More research needs to be done to further test and develop the model in practice.
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Affiliation(s)
- Marc Haufe
- University for Humanistic Studies, The Netherlands
| | - Carlo Leget
- University for Humanistic Studies, The Netherlands
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Guldin MB, Leget C. The integrated process model of loss and grief - An interprofessional understanding. DEATH STUDIES 2023; 48:738-752. [PMID: 37883693 DOI: 10.1080/07481187.2023.2272960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Despite the vast developments in research on loss and grief, dominant grief models fall short in reflecting the comprehensive issues grieving persons are facing. Three causes seem to be at play: grief is usually understood to be connected to death and other types of loss are under-researched; the majority of research is done from the field of psychology and on pathological forms of grief, hardly integrating research from other disciplines; and the existential suffering related to grief is not recognized or insufficiently integrated in the dominant models. In this paper, we propose an integrated process model (IPM) of loss and grief, distinguishing five dimensions of grief: physical, emotional, cognitive, social, and spiritual. The integrated process model integrates therapies, tools, and models within different scientific theories and paradigms to connect disciplines and professions. The comprehensive and existential understanding of loss and grief has relevance for research, clinical settings and community support.
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Affiliation(s)
- Mai-Britt Guldin
- Research Unit for General Practice, Institute for Public Health, Aarhus University, Denmark. Center for Grief and Existential Values, Aarhus, Denmark
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, The Netherlands
- Center for Grief and Existential Values, Aarhus, Denmark
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Yu H, Sun C, Xie L, Wang L, Song J, Zhu Y, Xiao R, Lowe S, Bentley R, Zhou D. Using a mediating model of death attitude and meaning in life to understand nursing students attitude about hospice care. NURSE EDUCATION TODAY 2022; 116:105448. [PMID: 35779526 DOI: 10.1016/j.nedt.2022.105448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/03/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nurse-led hospice teams are an emerging trend in contemporary health care practice in China. However, Chinese nursing students are often ill-prepared to work in hospice care. Study findings on the attitude of nursing students toward the care of people who are dying and death varied among different countries and regions. OBJECTIVES To propose and empirically test a mediating model that examines how death attitude and meaning in life interact to affect Chinese undergraduate nursing students and their attitude toward the care of people who are dying. DESIGN A cross-sectional study. PARTICIPANTS A convenience sample of 1410 Chinese undergraduate nursing students. METHODS Data were collected from July to December 2020 using Chinese versions of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-C), Death Attitude Profile-Revised (DAP-R-C), and Purpose in Life Test (CPLT-C). SPSS version 22.0 and AMOS version 24.0 were used for statistical analysis. RESULTS The average FATCOD-B-C score was 98.28 ± 8.02. Death attitude and meaning in life were positively correlated with attitude toward care of the dying (p < 0.001), but death attitude was negatively correlated with meaning in life (p < 0.001). Pathway analysis showed that fear of death was significantly and positively correlated with attitude toward care of people who are dying. A mediating role was found among neutral acceptance, escape acceptance, and meaning in life to some extent. Meaning in life suppressed effects among the model. CONCLUSION This study revealed that Chinese undergraduate nursing students' attitude toward care of the dying was a positive nurturing process. Future nurse education should first identity the fear of death, neutral acceptance, or escape acceptance of nursing students' death attitude, and then develop a hospice curriculum based on fear management.
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Affiliation(s)
- Huan Yu
- School of Nursing, Anhui Medical University, Hefei 230032, Anhui, China.
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago 60657, IL, USA.
| | - Lunfang Xie
- School of Nursing, Anhui Medical University, Hefei 230032, Anhui, China
| | - Lu Wang
- School of Nursing, Anhui Medical University, Hefei 230032, Anhui, China
| | - Jiangyan Song
- Department of Nursing, Clinical Medical College, Anhui Medical University, Hefei 230032, China
| | - Yu Zhu
- School of Nursing, Anhui University of Chinese Medicine, Hefei 230012, Anhui, China
| | - Rui Xiao
- Intensive Care Unit, Yingshan County People's Hospital, Yingshan 637700, Sichuan, China
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| | - Rachel Bentley
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| | - Danye Zhou
- School of Nursing, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, USA
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Haufe M, Leget C, Glasner T, Teunissen S, Potma M. Spiritual conversation model for patients and loved ones in palliative care: a validation study. BMJ Support Palliat Care 2022:bmjspcare-2022-003569. [PMID: 35710709 DOI: 10.1136/bmjspcare-2022-003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In palliative care, validated tools for professionals that facilitate day-to-day spiritual conversations with patients and loved ones are scarce. The objective of this study was to validate the Diamond spiritual conversation model across different palliative care settings as well as professional and educational levels. METHODS An online survey was filled in by 387 professionals providing palliative care for patients in hospice, home care, hospital and nursing home settings. The five polarities of the Diamond model: holding on-letting go, doing-undergoing, remembering-forgetting, me-the other and believing-knowing were operationalised and evaluated on reported occurrence. RESULTS In conversations with patients, palliative care professionals reported letting go of loved ones (81.8%), dealing with pain and suffering (88.1%), dealing with issues from the past (67.2%), dealing with own versus loved one's wishes (69.4%) and giving meaning to death (66.7%) as themes occurring regularly to very often. In conversations with loved ones, this was 70.8%, 78.5%, 55.4%, 68,8% and 62%, respectively. Respondents working in hospices reported these themes significantly more than those working in home care settings, nursing homes or hospitals. Nurse assistant respondents reported the themes significantly less than nurses or chaplains. CONCLUSION From the perspective of professionals providing palliative care in different palliative care settings, the Diamond model offers a validated framework for addressing relevant spiritual themes for patients and loved ones.
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Affiliation(s)
- Marc Haufe
- Department of Care Ethics, University for Humanistic Studies, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University for Humanistic Studies, Utrecht, The Netherlands
| | - Tina Glasner
- Department of Research Methodology, University for Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Center of Expertise Palliative Care Utrecht, Julius Center for Healthcare Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Potma
- Department of Care Ethics, University for Humanistic Studies, Utrecht, The Netherlands
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Green C. Nurses and Patients' Perspectives on Spiritual Health Assessment. JOURNAL OF RELIGION AND HEALTH 2021; 60:122-133. [PMID: 33140313 DOI: 10.1007/s10943-020-01113-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.
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Affiliation(s)
- Cheryl Green
- Southern Connecticut State University, 501 Crescent Street, Jennings Hall Nursing Department, New Haven, CT, 06515, USA.
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de Vries S, Lormans T, de Graaf E, Leget C, Teunissen S. The Content Validity of the Items Related to the Social and Spiritual Dimensions of the Utrecht Symptom Diary-4 Dimensional From a Patient's Perspective: A Qualitative Study. J Pain Symptom Manage 2021; 61:287-294.e2. [PMID: 32777457 DOI: 10.1016/j.jpainsymman.2020.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023]
Abstract
CONTEXT In palliative care, caregivers often lack words and competences to discuss patients' needs in social and spiritual dimensions. The Utrecht Symptom Diary-4 Dimensional (USD-4D) is an instrument that can be used to monitor symptoms and needs in the physical, psychological, social, and spiritual dimensions and to optimize communication between patients and caregivers. OBJECTIVE To assess the content validity of the USD-4D items related to the social and spiritual dimensions from a patient's perspective, measured in terms of comprehensibility, relevance, and comprehensiveness. METHODS An explorative qualitative study was conducted using in-depth semistructured interviews and thematic analysis. Twelve participants (male N = 7, 53-87 years old) with an estimated life expectancy of less than one year were recruited in two home care services: a general hospital and a hospice. RESULTS The instructions, items, and response options were comprehensible for almost all participants. The meaning that was provided to the items was expressed in themes: maintaining personal identity and autonomy, resilience, letting go, perceived balance in one's life, and death and afterlife. This corresponds with the intended meaning. The items were relevant at some points in time. Not all participants had needs for personal care during the interviews. Participants found the USD-4D comprehensive, no key concepts related to the social or spiritual dimensions appeared to be missing. CONCLUSIONS The USD-4D constitutes a content valid PROM from the patient's perspective. The items support patients in identifying needs in the social and spiritual dimensions and in the conversation to further explore these needs.
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Affiliation(s)
- Sita de Vries
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom Lormans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Everlien de Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo Leget
- Chair of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature. Med Sci (Basel) 2019; 7:medsci7020025. [PMID: 30736416 PMCID: PMC6409788 DOI: 10.3390/medsci7020025] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 12/28/2022] Open
Abstract
Many studies on spiritual care in palliative care are performed in the US, leaving other continents unexplored. The objective of this systematic review is to map the recent studies on spiritual care in palliative care in Europe. PubMed, CINAHL, ATLA, PsycINFO, ERIC, IBSS, Web of Science, EMBASE, and other databases were searched. Included were European studies published in a peer-reviewed journal in 2015, 2016, or 2017. The characteristics of the included studies were analyzed and a narrative synthesis of the extracted data was performed. 53 articles were included. Spiritual care was seen as attention for spirituality, presence, empowerment, and bringing peace. It implied creative, narrative, and ritual work. Though several studies reported positive effects of spiritual care, like the easing of discomfort, the evidence for spiritual care is low. Requirements for implementation of spiritual care in (palliative) care were: Developing spiritual competency, including self-reflection, and visibility of spirituality and spiritual care, which are required from spiritual counselors that they participated in existing organizational structures. This study has provided insight into spiritual care in palliative care in Europe. Future studies are necessary to develop appropriate patient outcomes and to investigate the effects of spiritual care more fully.
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Assing Hvidt E, Hansen DG, Ammentorp J, Bjerrum L, Cold S, Gulbrandsen P, Olesen F, Pedersen SS, Søndergaard J, Timmermann C, Timm H, Hvidt NC. Development of the EMAP tool facilitating existential communication between general practitioners and cancer patients. Eur J Gen Pract 2017; 23:261-268. [PMID: 28799437 PMCID: PMC8816390 DOI: 10.1080/13814788.2017.1326479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND General practice recognizes the existential dimension as an integral part of multidimensional patient care alongside the physical, psychological and social dimensions. However, general practitioners (GPs) report substantial barriers related to communication with patients about existential concerns. OBJECTIVES To describe the development of the EMAP tool facilitating communication about existential problems and resources between GPs and patients with cancer. METHODS A mixed-methods design was chosen comprising a literature search, focus group interviews with GPs and patients (n = 55) and a two-round Delphi procedure initiated by an expert meeting with 14 experts from Denmark and Norway. RESULTS The development procedure resulted in a semi-structured tool containing suggestions for 10 main questions and 13 sub-questions grouped into four themes covering the existential dimension. The tool utilized the acronym and mnemonic EMAP (existential communication in general practice) indicating the intention of the tool: to provide a map of possible existential problems and resources that the GP and the patient can discuss to find points of reorientation in the patient's situation. CONCLUSION This study resulted in a question tool that can serve as inspiration and help GPs when communicating with cancer patients about existential problems and resources. This tool may qualify GPs' assessment of existential distress, increase the patient's existential well-being and help deepen the GP-patient relationship.
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Affiliation(s)
- Elisabeth Assing Hvidt
- a Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark
| | - Dorte Gilså Hansen
- a Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark
| | - Jette Ammentorp
- b Institute of Regional Health Research, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark.,c Health Services Research Unit , Lillebaelt Hospital , Vejle , Denmark
| | - Lars Bjerrum
- d Department of Public Health, Section of General Practice and Research Unit for General Practice , University of Copenhagen , Copenhagen , Denmark
| | - Søren Cold
- a Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark.,e Department of Oncology, Medical Faculty , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Pål Gulbrandsen
- f Department of Social Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.,g HØKH Research Centre , Akershus University Hospital , Lorenskog , Norway
| | - Frede Olesen
- h Department of Public Health, The Research Unit for General Practice , Aarhus University , Aarhus , Denmark
| | - Susanne S Pedersen
- i Department of Psychology, Unit of Medical Psychology, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark.,j Department of Cardiology , Odense University Hospital , Odense , Denmark
| | - Jens Søndergaard
- k Research Unit of General Practice , University of Southern Denmark , Odense , Denmark
| | - Connie Timmermann
- b Institute of Regional Health Research, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark.,c Health Services Research Unit , Lillebaelt Hospital , Vejle , Denmark
| | - Helle Timm
- l The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), National Institute of Public Health , University of Southern Denmark , Odense , Denmark
| | - Niels Christian Hvidt
- a Department of Public Health, Research Unit of General Practice, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark
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de Graaf E, van Klinken M, Zweers D, Teunissen S. From concept to practice, is multidimensional care the leading principle in hospice care? An exploratory mixed method study. BMJ Support Palliat Care 2017; 10:e5. [PMID: 28167657 DOI: 10.1136/bmjspcare-2016-001200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/21/2016] [Accepted: 01/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospice care (HC) aims to optimise the quality of life of patients and their families by relief and prevention of multidimensional suffering. The aim of this study is to gain insight into multidimensional care (MC) provided to hospice inpatients by a multiprofessional team (MT) and identify facilitators, to ameliorate multidimensional HC. METHODS This exploratory mixed-method study with a sequential quantitative-qualitative design was conducted from January to December 2015. First a quantitative study of 36 patient records (12 hospices, 3 patient records/hospice) was performed. The outcomes were MC, clinical reasoning and assessment tools. Second, MC was qualitatively explored using semistructured focus group interviews with multiprofessional hospice teams. Both methods had equal priority and were integrated during analysis. RESULTS The physical dimension was most prevalent in daily care, reflecting the patients' primary expressed priority at admission and the nurses' and physicians' primary focus. The psychological, social and spiritual dimensions were less frequently described. Assessment tools were used systematically by 4/12 hospices. Facilitators identified were interdisciplinary collaboration, implemented methods of clinical reasoning and structures. CONCLUSIONS MC is not always verifiable in patient records; however, it is experienced by hospice professionals. The level of MC varied between hospices. The use of assessment tools and a stepped skills approach for spiritual care are recommended and multidimensional assessment tools should be developed. Leadership and commitment of all members of the MT is needed to establish the integration of multidimensional symptom management and interdisciplinary collaboration as preconditions for integrated multidimensional HC.
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Affiliation(s)
- Everlien de Graaf
- Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merel van Klinken
- Department of Pain and Supportive Care, Netherlands Cancer Institute Anthoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Danielle Zweers
- Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Teunissen
- Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
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Vermandere M, Warmenhoven F, Van Severen E, De Lepeleire J, Aertgeerts B. Spiritual history taking in palliative home care: A cluster randomized controlled trial. Palliat Med 2016; 30:338-50. [PMID: 26376936 DOI: 10.1177/0269216315601953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many health-care providers experience barriers to addressing spiritual needs, such as not having the right vocabulary. The ars moriendi model might be a feasible tool for spiritual history taking in palliative care. AIM To investigate the effect of a structured spiritual history taking on the spiritual well-being of palliative patients in home care. DESIGN Cluster randomized controlled trial, conducted between February and October 2013. PATIENTS AND METHODS Registered nurses and general practitioners approached eligible patients with an incurable, life-threatening disease for study participation. Health-care providers allocated to the intervention arm of the study took a spiritual history on the basis of the ars moriendi model. Health-care providers in the control arm provided care as usual. Patient-reported outcomes on spiritual well-being, quality of life, pain, and patient-provider trust were assessed at two points in time. RESULTS A total of 245 health-care providers participated in the study (204 nurses and 41 physicians). In all, 49 patient-provider dyads completed the entire study protocol. The median age of the patients was 75 years (range: 41-95 years), and 55% of the patients were female. There were no significant differences at any point in time in the scores on spiritual well-being, quality of life, pain, or patient-provider trust between the intervention and the control group. CONCLUSION This cluster randomized controlled trial showed no demonstrable effect of spiritual history taking on patient scores for spiritual well-being, quality of life, health-care relationship trust, or pain. Further research is needed to develop instruments that accurately assess the effectiveness of spiritual interventions in palliative care populations.
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